title: "Occult" ovarian Leydig cell tumor: when laboratory tells more than imaging.
abstract: Hyperandrogenism is a common finding in premenopausal age and is generally caused by polycystic ovarian syndrome or other benign disease. Androgen-secreting tumors represent only 0.2 % of the causes of hyperandrogenism and usually present with severe clinical features, abrupt onset, and very high androgens levels. We describe here three cases of occult ovarian Leydig cell tumors suspected on the basis of severe clinical features of hyperandrogenism rapidly worsening, with elevated serum total testosterone levels, in which bilateral ovariectomy was performed and tumor was confirmed by post-operative histology. In all three cases, imaging was negative for ovarian tumor. Moreover, in one case the confounding concomitant finding of bilateral adrenal masses posed an additional challenge. Our experience highlights that testosterone levels represent the most helpful marker in the diagnosis of androgen-secreting ovarian tumor. In the absence of imaging findings, bilateral ovariectomy should be indicated, if supported by unequivocal clinical and laboratory data.
authors.affiliation: Endocrinology Unit, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy.
authors.forename: Rosa Maria
authors.initials: RM
authors.lastname: Paragliola
authors.forename: Francesco
authors.initials: F
authors.lastname: Torino
authors.forename: Paola
authors.initials: P
authors.lastname: Senes
authors.forename: Laura
authors.initials: L
authors.lastname: Castellino
authors.forename: Vanda
authors.initials: V
authors.lastname: Salutari
authors.forename: Alfredo
authors.initials: A
authors.lastname: Pontecorvi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Scambia
authors.forename: Salvatore M
authors.initials: SM
authors.lastname: Corsello
mesh_terms: D000328:Adult; D000368:Aged; D003952:Diagnostic Imaging; D005260:Female; D006628:Hirsutism / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D006801:Humans; D017588:Hyperandrogenism / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D007984:Leydig Cell Tumor / Q000150:complications / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery; D013739:Testosterone / Q000097:blood; D016896:Treatment Outcome
chemical_list: D013739:Testosterone